HIV Positive Patients On Tenofovir At Increased Risk Of Kidney Damage

A�new study led by scientists at the UCSF,�performed on a batch of more than 10,000 patients, revealed that patients on antiretroviral therapy with tenofovir associate a higher risk of kidney damage and CKD (chronic kidney disease). The study also found that tenofovir use is also correlated with an increased risk of developing kidney disease in patients who lacked the most common risk factors for kidney disease, and the resulted kidney toxicity may be irreversible.

Tenofovir Drug

The study results call for increased screening for HIV positive�patients on tenofovir�who�also associate other kidney disease risk factors and are at high risk of developing chronic kidney disease.

The study revealed that for each year of tenofovir use, the risk of proteinuria (excess of serum proteins in the urine) raises with approximately thirty-four percent, the risk of acute kidney failure raises with�eleven percent and the risk of developing CKD raises with�thirty-three percent. The risks remain unchanged also, after researchers checked for other kidney disease risk factors that include patient’s age, race, presence of�other conditions such as hypertension, diabetes�and smoking.

The risk percentage of patients on tenofovir compared to patients on other antiretroviral drugs was thirteen percent compared to�eight percent for proteinuria, nine percent compared to five percent for acute renal failure and two percent compared to only one percent for chronic kidney disease.

Patients were observed for about one year and two months after they dropped out of�therapy with tenofovir. The risks for developing kidney disease remained elevated for a period�between six and one year compared to those who have never�been treated with tenofovir. This fact�reveals that�kidney damage is not quickly reversible.�The long term prognosis for�patients who developed kidney disease and�stopped taking tenofovir�remains unknown.

To be sure that tenofivir was the actual culprit, researchers at the San Francisco VA Medical Center and the University of California, San Francisco (UCSF) studied the effects of eighteen other drug associations used for treating HIV positive patients on the same kidney disease markers: proteinuria, fulminant renal failure and progression to chronic kidney disease. None of these eighteen associations could be correlated with an increased risk.

Tenofovir is currently used to lower viral loat and boost immune system function in HIV positive patients. Statistically it is one of the most prescribed anti-HIV drug and the preferred first line choice due to its dosing convenience, relatively low toxicity and good potency.�In pharmacies, it�can be found�under a wide variety of brand names as well as in�different�combinations with other drugs.

Ways To Prevent Heartburn During The Winter Holidays

During�winter holidays, cramps, bloating�and heartburn are the main health problems a person usually experiences�due to excessive food consumption.�Holidays usually turn into a prolonged feast, with various types of food, salads, steaks, cookies and so on. Winter holiday menus are usually composed of the main foods that cause heartburn. Here are some tips that will help�you prevent these type of�problems, so you�can�enjoy the winter�holidays peacefully.

Enjoy your food but do not�be greedy. The�quantity of food you serve at a meal is very important. Do not fill�your�plate to the brim , place small portions of each dish and serve them�with moderate sips and without any�haste, so you can avoid nausea�that usually occurs after a greedy and excessive food�consumption. This way�you can really enjoy�the�taste�of each dish.

Avoid copious meals. It does not only�matter how much you eat but also what you eat. Surely you know, or suspect that foods high in fat are an enemy of the body, but do not forget that sugar�fits into this category too. If you have to choose between mashed potatoes and pumpkin pie, mashed�potatoes would be the�best choice�as it�can help calm the heartburn. According to studies, foods that have high amounts of sugar in�their composition,�are a more important�issue than complex carbohydrates.

Copious Meal

Pay��attention to�desert! One of�biggest diet�enemies�during holidays is desert. Chocolate cakes, cakes with plenty of cream, candy,� are usually responsible for heartburn.

Start dinner with appetizers. Before the main�meal, appetizers are ideal�in�order�to prevent heartburn. Opt for shrimp, salmon and other foods rich in protein and low in fat. Vegetable salads are also a good choice, but pay�attention to the amount of dressing or mayonnaise sauce.

Opt for substitutes. Nobody expects to “jump” over dessert at Christmas dinner, but opt ??for the�best dessert: instead of a chocolate cake, choose a fruit salad. Thus, you prevent heartburn and excess calories.

Do not rush yourself. If�you eat�in a hurry�and�return to previous activities, you will have the unpleasant surprise of feeling bloated and lacking energy. Schedule your work and give enough time so you can quietly enjoy your meals. Studies show that heartburn is more common when meals are served quickly.

Exercise! After a big meal, everyone is tempted to stretch and relax in front of the TV. But this attitude is wrong because�for proper digestion, exercise is needed�so go for a short walk outdoors or relax with some�simple exercises. No matter how tired you feel it is better�to stand� that lie in your bed because gravity�prevents the gastroesophageal reflux.

Rest on your left side. In case you feel tired after a meal and it is absolutely required to rest,� lie on�your left�side. This advice is based on the anatomy of the esophagus, which relate to the stomach on the right side.

Drink a glass, but do not�exaggerate. A glass of wine or champagne will not affect the stomach, but finishing the bottle�will make a difference. As alcohol consumption increases, the esophagus sphincter relaxes causing reflux.

Prepare for�a possible�heartburn. Make sure you have at hand the necessary medication in case of heartburn.

Polycythemia Vera

Polycythemia vera is a blood disorder in which the�bone marrow produces excess�blood cells�(erythrocytes, platelets and leukocytes). Excess blood cells causes a�thickening�of the blood leading to�increased coagulation risk, which�in turn�can�lead to�stroke, myocardial infaction and other complications. The exact cause of polycythemia is unknown, but it is assumed that development of the disease is�influenced by certain�genetic changes. Polycythemia or polycythemia vera gene evolves slowly and is especially common in older people, and quite�rare in young children. Although�polycythemia vera is a�result of a�genetic mutation, these genetic abnormalities are usually acquired during the life of an individual and�are not�transmitted generally from parents to children. The condition is more common in adults over 60 years

Polycythemia�Symptoms

In the first phase of polycythemia vera, symptoms are mild and include flushing, dizziness and impaired senses. In more severe cases�thrombosis can occur�(blood clotting), which leads to more serious manifestations. In later stages of polycythemia vera,�long-term presence of oxygen deprivation signs are present�(as in the case of chronic smokers or people who spend long periods at high altitudes) due to increased production of red blood cells and blood thickening. This form of polycythemia�disappears�when�the oxygen deprivation cause is treated.

Polycythemia Vera

However, in all cases of polycythemia, improvements can be achieved�by removing a quantity of blood periodically until the number of erythrocytes in blood�is reduced�(phlebotomy) or administering drugs�that reduce the number of blood cells. Unfortunately�a permanent cure for the disease does not exist.

Although polycythemia is quite rare and can be controlled, sometimes serious complications can occur such as�a heart attack or stroke,�in case of lack of�treatment. Emergency medical intervention will be required�for any symptoms that occur�suddenly like weakness, confusion, vision problems or chest pain that persists.In early stages, polycythemia vera produces no symptoms. However as the disease progresses�one or more polycythemia vera symptoms may be present

• Headaches
• Dizziness
• Itching especially after bathing with hot water
• Skin redness
• Shortness of breath
• Shortness of breath while�lying down
• Numbness, tingling, burning or weakness in hands, feet, arms
• Feeling of fullness or bloating in the left upper abdomen due to�splenomegaly
• Fatigue.

Polycythemia�Vera�Causes

Polycythemia vera develops when a mutation in a cell�in the bone marrow�causes�blood cell production problems. Normally, the body carefully regulates the number of existing�blood three cell types but in polycythemia vera, the mechanism used by the body to control blood cell production is impaired and the bone marrow produces too many blood cells. Mutation that causes polycythemia vera role affects a protein that�signals cells to grow (JAK2 V617F mutation). Most people with polycythemia vera have this mutation.

Physicians and researchers could not fully determine the role of this mutation and its implications during studies that searched for a treatment. Scientists believe that the mutation occurs after conception therefore is acquired rather than inherited.

Polycythemia Vera�Risk Factors

Factors that may increase the risk of developing polycythemia vera are:

• Advanced age – chances of developing polycythemia vera increases with age, being more common in adults over the age of 60 years and�quite rare�in people who are under 20 years
• Males – polycythemia vera effects�with predilection men
• Medical history – family history of�polycythemia vera�(especially relatives) increases the risk for developing the disease.

Any person�should consult a physician�if �any specific signs or symptoms of polycythemia vera are present. Because�polycythemia vera�causes a thickening of the blood�it increases the risk of developing blood clots. If a clot reaches the blood vessels of the head, it can cause a stroke.�Immediately�seek emergency care if any of�the signs�or symptoms of a stroke are present such as:

• Sudden numbness, weakness, paralysis of the face, limbs – usually on one side
• Difficulty in understanding speech
• Sudden dizziness, loss of balance or coordination
• Sudden pain, headache that might be accompanied by stiff neck, facial pain, vomiting or altered consciousness
• Confusion or impaired memory,�poor spatial orientation or perception.

Polycythemia Vera�Treatment

Polycythemia vera�is treated�using�blood thinners to prevent�clots formation. This can be done by periodic blood collection to reduce red blood cell count. In some cases, drugs that suppress the action of�the bone marrow�like hydroxyurea and interferon can be administered. To prevent blood clots formation aspirin can be also used, but less frequently�as it may be a triggering factor for a�bleeding stomach.

Polycythemia Vera�Complications

Progression of polycythemia vera is usually�slow and most patients do not suffer complications if the disease is well�treated. In some rare�complication can occur unfortunately and�are serious enough�to�cause�strokes and heart attacks.

In addition to bone marrow dysfunction, polycythemia vera can�lead to myelofibrosis (scarring of the bone marrow) or in very rare cases, to�leukemia. These consequences can be life threatening and the patient should be treated immediately. The risk of serious complications can be minimized by following a correct treatment plan.

Complications of polycythemia vera include:

• Blood clots (thrombosis)
• Enlarged spleen (splenomegaly)
• Gastrointestinal bleeding
• Gout
• Heart failure
• Leukemia
• Myelofibrosis
• Peptic ulcer.

Anti-HIV Drugs Can Reduce Complications Of Graft-Versus-Host-Disease, According To New Study

Researchers from the Perelman School of Medicine at the University of Pennsylvania revealed that a drug which is used for HIV treatment can reduce dangerous complications of graft-versus-host-disease in blood cancer patients that underwent an allogenic bone marrow transplantation. This anti-HIV drug redirects the traffic of� immune cells to certain organs, thus suppressing the immune system, reduces the risk of developing graft-versus-host- disease. Maraviroc, the anti-HIV drug which redirects the immune cells, can reduce the occurrence of graft-versus-host-disease complications, without suppression of the�immune system.

“There hasn’t been a change to the standard of care for graft-versus-host-disease since the late 1980s, so we’re very excited about these results, which exceeded our expectations. Until now, we thought that only extreme suppression of the immune system can get rid of graft-versus-host-disease, but in this approach we are not killing immune cells or suppressing their activity, we are just preventing them from moving into certain sensitive organs that they could harm.” says Ran Reshef, MD, an assistant professor in the division of Hematology-Oncology and a member of the Hematologic Malignancies Research Program at Penn’s Abramson Cancer Center.

The researchers demonstrated that Maraviroc is a very good and safe drug�that�can be used in�patients that underwent a allogenic bone marrow transplantation. After administration 73 percent of patients did not presented graft-versus-host-disease complications and 6 percent developed sever graft-versus-host-disease, six months after transplant, compared with a control group in which 22 percent developed sever graft-versus-host-disease.

“Just like in real estate, immune responses are all about location, location, location. Cells of the immune system don’t move around the body in a random way. There is a very distinct and well orchestrated process whereby cells express particular receptors on their surface that allow them to respond to small proteins called chemokines. The chemokines direct the immune cells to specific organs, where they are needed, or in the case of graft-versus-host-disease, to where they cause damage.”, Reshef said.

T lympocytes

Thirty-eight patients with acute myeloid leukemia, myelodysplastic syndrome, lymphoma, myelofibrosis were included in this clinical trial. They received the standard therapy for graft-versus-host-disease that includes methotrexate and tracomlimus. Two days before the bone marrow transplantation they began a 33-day course of maraviroc. None of the patients that were treated with maraviroc developed graft-versus-host-disease, in the first 100 days after the�bone marrow transplant, compared with the control group where 12.5 percent developed� graft-versus-host-disease in the gut and 8.3 percent developed graft-versus-host-disease in the liver, in the first 100 days after transplant.

These findings indicate that maraviroc is very useful in preventing graft-versus-host-disease, by limiting the mobilization of T lymphocytes in certain organs in the body. This anti-HIV drug�works by�blocking the�CCR5 receptor�of the lymphocytes, thus preventing the mobilization of this cells to certain organs.

After 180 days of maraviroc treatment, the incidence of gut and liver complications of graft-versus-host-disease was 8.8 percent for the gut and 2.9 percent for the liver.� In the control group, the incidence of this complications remained higher, 28.4 percent for gut and 14.8 percent for liver complications of graft-versus-host-disease.

The researchers also observed that maraviroc treatment did not influence the relapse rate of the underlying disease or increase the disease treatment toxicity.

New Achilles Heel In Cancer Cells Discovered By Scientists

Researchers at the Cancer Research, UK have�discovered that cancerous cells retain a certain toxic protein�making them able to avoid apoptosis (programmed cell death). The discovery could lead to a new cancer�treatment target. The study was published today in Nature Cell Biology online magazine.

During the study�researchers removed a protein name FAK from cancerous cells grown in the lab�and mice with cancer. The FAK protein combined with another protein named SRC work together and promote tumor dissemination and development. Removing the FAK protein, leaves the SRC protein unpaired which alone, in high amounts�is very toxic for cancerous cells leading therefore to apoptosis. The only�problem is researchers also found that, cancerous cells can adapt and eliminate the unbinded SRC protein and�avoid death.

Scientists discovered that cancerous cell can actually digest the excess SRC protein (autophagy)�by including them in vacuoles (organelle major�with a role in maintaining a balance between the production and degradation, of�certain�substances and�cellular structures). It was not previously know that cancerous cell can actually dispose SRC protein using this mechanism.

Cancerous Cells

The conclusion�was that by blocking FAK protein and also preventing cancerous cells from removing SRC could lead to apoptosis and therefore a new powerful treatment option for patients suffering from cancer.

Apoptosis is a form of programmed cell death,�that�triggers the process by which cells self-distruct� in response to a signal. This process is genetically programmed. As a biological phenomenon, apoptosis has a great significance. A faulty development of apoptosis is the main cause of many diseases. Excessive cell loss characterizes Parkinson’s disease, while an insufficient apoptosis may involve uncontrolled cell proliferation, a mechanism underlying cancer.

Normally when healthy cells are getting old or damaged, they automatically trigger the apoptosis process but cancerous cell have managed to find new ways to continue to develop and divide. By knowing how exactly cancerous cells can cheat death and� could lead to a total healing treatment

Drugs�already in development,�that act by blocking the�FAK protein, combined with a method that could stop the cells from disposing excess toxic SRC could lead to apoptosis.

Orcein

A red�dye extracted from lichens, that has been used for hundreds of years to color food and clothing, appears to�reduce the number of small toxic protein aggregates that can be found in patients suffering from Alzheimer’s disease. The dye, named orcein and a close related compound named O4, attach preferentially to small protein aggregates that are considered to be responsible for Alzheimer’s disease.

The remarkable thing is that, the O4 binding to protein aggregates leads to the formation of mature plaques, which researchers consider to be non-toxic for neurons. On the other hand further testing on animal models is needed in�order�to confirm Dr. Jan Bieschke, Dr. Martin Herbst and�Professor Erich Wanker�theory and determine whether these molecules could be useful for developing new treatment options for patients suffering from Alzheimer’s disease.

The main cause of Alzheimer’s disease is considered to be protein misfolding. Protein misfolding is a process which takes place in several phases� that determines proteins to build up�creating�very large intracellular plaques. Scientists think that small protein aggregates represent the building�foundation for mature plaques that are�toxic to neurons leading to their death.

The natural dye named orcein is extracted from lichens (group of organisms, resulting from the�permanent cohabitation between a fungus and an alga) that grow on the Canary Islands. Natural dyes have been used for hundreds of years for coloring different kinds of fabrics and food.

Orcein Red Dye

Professor Wanker started eight years ago�to screen hundreds of�natural compounds�to find drug�molecule candidates that�he could use to develop new treatments�for neurodegenerative disorders. Among many candidates, he isolated orcein, a natural dye that is composed of�fourteen small molecules. As these fourteen molecules can have various�biological effects,�Professor Wanker started to search for pure�substances that�have�similar effects. A blue dye name�O4 very much like orcein was then�isolated that was proved to�encourage the�formation of large protein plaques that are non-toxic to neurons.

Until now researches found that stopping the formation of small toxic protein assemblies is very difficult to achieve.�But if�Professor Wanker is right, and small aggregates are indeed�precursors of plaque formation,�O4 could be regarded as a new attack mechanism against Alzheimer’s disease.

However, it is yet unclear�whether O4 can be effective in reducing the amounts of misfolded proteins therefore�effective in�symptoms relief�in�human models suffering from Alzheimer’s disease.

Vaccinations Recommended For Adults

Vaccines offer protection�against various serious or life-threatening�illnesses. But�what are the necessary vaccines for adults? This may be unclear, especially for people who have been vaccinated�during childhood. Below�you can find a series of vaccines recommended by physicians to control and prevent some common�diseases.

Flu vaccine�– seasonal influenza

Who needs this vaccine? The flu shot is recommended for most adults. Vaccination is especially important for people with chronic diseases or compromised immune systems, for those who work in medical facilities, living in health care institutions, live with anyone who has a high risk�for developing complications as a result of influenza (children under the age of five�for example). Injectable flu vaccine is recommended including�to�pregnant women.

The�flu vaccine will be administered, ideally in October or November.

Contraindications

The influenza vaccine is not recommended for people allergic to eggs, those who had an allergic reaction to a previous flu vaccine or those who are sick at the time of vaccine administration. Those who suffered from Guillian-Barre syndrome, should�consult�their doctor before taking this vaccine.

Pneumococcal Polysaccharide Vaccine

Who needs this vaccine? Pneumococcal polysaccharide vaccine should be given to persons who are older than 65, those who suffer from chronic illnesses or weakened immune systems, those who underwent a splenectomy or living in health care institutions or�are long-term smokers.

This type of vaccine can be administered at any point. People who are under 65 years will receive a second dose, but only they suffer from a specific health condition and received the first dose five or more years ago.

Patients over 65 years who received the first dose of vaccine before the�age of�65 (not in the last�five years), who have a weakened immune system, kidney disease, underwent a splenectomy�or bone marrow transplantation�should receive a second dose of vaccine.

Contraindications

The vaccine is not indicated in individuals who experienced an allergic reaction to a previous vaccination against pneumonia or who are currently sick.

Combined�Vaccine –�diphtheria, tetanus, acellular pertussis, diphtheria – TDaP

Who needs this vaccine? – one dose�of TDaP�is recommended for all adults aged�between 19 and 65 years, regardless of when the last vaccine was�administered or the type of vaccine used before.

Vaccination is especially important for those who have suffered injuries that may infect, for those�in close contact with infants, women who have never�had the vaccine, those who wish to become pregnant or employees in medical facilities.

This type of vaccine will be given to those who have not received complete vaccination against tetanus and diphtheria. A second dose of vaccine will be inoculated�four weeks after the first dose and the third after 6 to 12 weeks after the second dose. Booster will�be administered each�10 years.

Contraindications

The vaccine is not recommended�in those who have had allergic reactions to previous doses,�in�pregnant women, or�those who have seizures or have�been in a coma. Also, those who suffer from epilepsy Barre-�Gullain syndrome�should consult their doctor before vaccinating.

Vaccine against human papillomavirus

Who needs this vaccine? Any person who is under 26 years and did not vaccinate�in adolescence. In men� the vaccine helps prevent genital warts and reduce transmission of the virus that can cause cervical cancer in women.

The dose can�be administered�at any time�and a�second dose two months after the first dose and the third at six months after the first dose.

Contraindications

HPV vaccine is not recommended�in�patients allergic to latex or yeast, those who have had an allergic reaction to a previous dose of vaccine, pregnant women or currently sick.

Hepatitis A Vaccine

Who needs the vaccine? – Hepatitis A vaccine�will be given to people who want to protect themselves�against this disease, those who have blood clotting disorders, chronic hepatitis, are sexually active, those who use different injectors, people who�could be exposed to hepatitis A and travel to other parts of the world where disease is common.

Hepatitis A vaccine can be�administered at any time. The next dose will be administered after�18 months.

Contraindications

Hepatitis A vaccine is not recommended for those who have had allergic reactions to a previous dose of vaccine or are�currently infected with hepatitis A virus.

Hepatitis�B Vaccine

Who needs this vaccine?� This vaccine�should be administered to people who want to protect themselves�against hepatitis B, have an active sex life, are drug uses, are under�treatment�that involves hemodialysis, health workers, those who are�living with a person who�suffers from a�chronic infection with hepatitis B or travels to different parts of the world where hepatitis B is very�common.

Hepatitis B vaccine can be administered at any time. The second dose will�be administered�one month after the first dose,the third� two months after the second and at least four months after the first dose.

Contraindications

Hepatitis B vaccine is not recommended for people allergic to yeast, those who have had an allergic reaction to a previous dose of vaccine or are currently infected.

Serotonin Can Stimulate Liver Cell Regeneration In Chronic Liver Disease

A team of researchers from Newcastle University discovered that serotonin receptors can be used by drugs to increase the natural healing proprieties of the liver. The study was published in Nature Medicine magazine.

Generally, when an organ is injured, the human body�tries to repair that�particular organ by forming scar tissue. In�all liver diseases, evaluation of tissue damage is based on the�balance between the degree of scar tissue formation and the degree of�normal liver cell regeneration. If the degree of scar tissue formation is higher than the degree of liver cell regeneration, then that liver disease progresses to cirrhosis, a condition in which the liver is unable to produce vital hormones and clotting factor or is unable to clean the blood. Liver cirrhosis is also consider�a risk factor for hepatic cancer.

This study which was published, Nature Medicine�describes how researchers were able to stimulate healthy tissue regeneration of the liver�and� block scar tissue formation by manipulating the actions of serotonin in mice with liver diseases.

Serotonin And Liver Cells Regeneration

In a liver injury, produced by a viral agent like hepatitis B, alcohol, by autoimmune or metabolic diseases, a specialized type of blood cells known as platelets are stimulated to repair the damaged tissue. When platelets are stimulated, they�start to�secrete serotonin. The researchers found that serotonin will stimulate the scar-forming cells, known as hepatic stellate cells to produce more scar tissue�therefore stopping the�healthy liver regeneration process. The scientists also discover that serotonin stimulates the hepatic stellate cells to produce scar tissue and inhibit normal regeneration of liver cells�by acting on a specific�a receptor called 5-HT2B. By�modifying the action of this receptor, the scientists were able to determine�the liver to increase the degree of liver cells regeneration and to decrease the degree of scar tissue formation.

Professor Derek Mann, research team leader stated: These are promising results in mouse models of liver disease and suggest that chemicals targeting 5-HT2B , which are currently in clinical trials for mood disorders and pulmonary hypertension might also have an application in the treatment of chronic liver disease.�

Scientists now�think that this particular�regeneration mechanism which was initially�found studying the liver may�also play a role in�regenerating other�organs. This discovery�may represent an�astonishing opportunity to study the regeneration process of other organs in the near�future leading to�possible�new treatments not only for patients suffering from chronic liver diseases.

Pituitary Dwarfism Causes, Symptoms, Diagnosis And Treatment

Pituitary dwarfism or dwarfism is a condition characterized by growth and development disorders caused by insufficient secretion of pituitary �somatotrope�hormone (growth hormone or GH). The condition begins in childhood, but becomes more evident�during puberty. Dwarfism is a condition in which growth is very slowed or delayed. Pituitary dwarfism is a consequence of decreased function of the pituitary gland�occurred early in childhood before the ossification of bone�cartilages.

Pituitary Dwarfism Causes

Pituitary dwarfism is caused by various�disorders of�the pituitary gland�function. The pituitary gland is an organ the size of a pea, located at the base of the brain,�rests in a small, bony cavity called the Turkish saddle. This gland is divided into three lobes:�anterior lobe�(Adenohypophysis)?, intermediate and posterior (Neurohypophysis). The�adenohypophysis produces�the�growth hormone (GH), adrenocorticotropin�(ACTH), thyroid stimulating hormone (TSH), prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH).�The neurohypophysis produce�the antidiuretic hormone (vasopressin) and oxytocin.

The growth process starts in the hypothalamus. The hypothalamus�provides a dual control�role upon�pituitary hormone secretion and autonomic nervous system activity.

The hypothalamus secretes GH-RH (growth hormone –�releasing hormone) that stimulates growth hormone secretion from the�adenohypophysis(GH). When growth hormone is released into the bloodstream�it trigger secretion in the liver of a hormone called insulin-like growth factor-1 (IGF-1). In turn, IGF-1 directly stimulates bone and muscle development, causing growth�of the�long bones and increased protein synthesis in the muscles. Because growth is a complex phenomenon, it can be slowed or stopped by abnormalities that occur in any part of this process.

Pituitary Dwarfism 2

There are two types of pituitary dwarfism:

• Pituitary dwarfism due to low adenohypophysis�production of hormones. When none of the previous pituitary hormones�are�properly produced, endocrine failure is�manifested on pituitary hormone dependent lines. It is characterized by slow overall growth, and patients�do not show signs of normal�puberty.
• Pituitary dwarfism due to isolated growth hormone deficiency. A common form of dwarfism is caused by deficiency in the production of pituitary growth hormone (GH). Patients are developed proportionally, reach sexual maturity and can�reproduce.

What causes pituitary dwarfism?

Pituitary dwarfism may be caused by:

• Genetic mutations – specific investigations are needed in order�to determine the specific genetic mutations that can cause pituitary dwarfism occurrence.
• Trauma (including surgery)�of�the pituitary gland
• Tumors, trauma or irradiation�of the�central nervous system
• Leukemia
• In most cases the cause of pituitary dwarfism is unknown – idiopathic.

Pituitary Dwarfism Symptoms

Children�with�pituitary have an�abnormal slow growth rate, however the body proportions of children suffering from growth hormone deficiency are normal. Children with a pituitary dwarfism�usually have a�stature 20-25% lower than�the normal�average age stature. Smaller stature is evident from the age of 2-4 years.�The cranial perimeter in children with growth hormone deficiency is usually normal.

Pituitary Dwarfism 3

Due to deficient degradation of fat, fat distribution in patients�is much higher than in normal�subjects�of the same�age, especially around the waist. Rarely excess fat deposits in the thighs, abdomen or in the mammary glands can occur.

In patients�with pituitary dwarfism,�protein synthesis�is diminished and the�muscle mass is proportionally�decreased�than in�normal individuals�of the same age. Studies show that�in children with pituitary dwarfism,�the skeletal muscle cells are less numerous than normal. Therefore, muscle strength, which can be measured in older children�using different�exercise tests, is�decreased.

Sexual organs are not sufficiently developed, women have the�uterus and vagina of�reduced dimensions, the�mammary glands are also underdeveloped. Amenorrhea is also present. In males the testicles are not descended into the scrotum, the penis and scrotum�have infant sizes.

Patients may have a normal�sex�life but�reproduction is�quite rare and it usually takes�place only in isolated deficiency of somatotropin cases.

Inadequate�degradation of glycogen to glucose can lead to�hypoglycemia and�seizures in severe and untreated hypoglycemia cases.

Intelligence�is mostly normal, but behavior�remains childish and�patients often�present asthenic type disorders, depression, inferiority complex.

The head and limbs�are too small, but proportionate, and this makes the overall appearance of the patient to be harmonic. The face is small, and due to the underdeveloped maxilla and mandible, the small�teeth�are intercalated. The nose is small, eyes very close to each other, but lively.

Pigmentation spots, freckles and fine wrinkles�can be present on the facial�skin.�Due to�these wrinkle, the patient gets�an appearance of early aging. Hands and feet are small, often�the skin�is�cyanotic.

Once puberty has passed, the patient retains the appearance of dwarf, skeleton and muscles remain undeveloped. Because the structure of the infant’s larynx, high-pitched voice in present�also in�adults.

In case of craniopharyngioma (a tumor located near the pituitary gland), children can have neurological symptoms such as headaches, vomiting, and vision problems (blurred vision, double vision).

Pituitary Dwarfism Diagnosis

Growth hormone deficiency�is present�at birth, but since the main symptom of pituitary dwarfism is�growth at a reduced rate, the disease is not diagnosed until later in childhood. Growth charts by age will help determine a diagnosis. Another diagnostic technique using�x-ray of the�hand (fist)�is used�to determine bone age comparing it with the child’s chronological age. Bone age in children with pituitary dwarfism is usually 2 or more years�delayed�than the actual�chronological age. This means that if a child with pituitary dwarfism is 10 years old, his bones will look like those of a child of 8 years.

Pituitary Dwarfism

Dosing�the growth hormone and IGF-1�(somatomedin�C) in blood is useful for diagnosis. Determination of growth hormone can be performed both in basal conditions and after stimulation (exercise, arginine, glucagon or insulin). Failure or inadequate response to stimulation tests�is associated with hypopituitarism.

Radiography�of the�“turkish saddle” (bone structure in which the pituitary gland rests)�or more advanced imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) can help the doctor to highlight the presence of�different tumors�of the pituitary gland .

Pituitary Dwarfism Treatment

To limit growth disorders in children with pituitary dwarfism growth hormone therapy is recommended�that is effective in a number of� as long as the treatment is started during�the�growth process.�Doses are�given as daily subcutaneous injection until the child reaches an appropriate height.
To receive treatment�based on�growth hormone, a lack of secretion of this hormone that was diagnosed by repeated�blood tests must be evidentiated�.

Dwarfism can be seen in other cases, but that growth hormone is normal:

• Turner syndrome is a genetic disease that affects only�girls. It is caused by complete or partial absence of a sex chromosome, leading to problems such as low height or reproductive difficulties.
• Children with renal failure, diabetes, tuberculosis, digestive disorders, heart disease and chronic infections
• Prader Willi syndrome is a chromosomal abnormality,�due to gene deletions of the short arm of chromosome 15 of paternal origin or both chromosomes 15 with�maternal origin. Syndrome traits are reduced fetal movements, obesity, hypotonia, mental retardation, short stature, hypogonadism, strabismus, small hands and feet. For these children, administration of growth hormone begins to show encouraging results.

A clear acceleration in the rate of growth of at least 4-7 cm / year indicates a positive response to treatment with growth hormone.
Between the�70’s and 80’s�natural growth hormone was�extracted from pituitary glands of cadavers. This hormone has been the source of transmission of a serious disease, Creutzfeld-Jacob. Today, synthetic growth hormone, genetically engineered is used fro treatment

If dwarfism is accompanied by sexual infantilism, treatment with sex hormones is added�– estrogen and progesterone – in girls and testosterone – in boys. Testosterone and its derivatives have the advantage to stimulates protein anabolism, develops muscles mass�and stature. Testosterone must be administered�with caution in children�due to its�virilizing effect.

Other drugs that increase endogenous production of growth hormone include: clonidine, arginine, dopamine, propranolol. Anabolic substances such as fluoxinesterone,� nandrolone�and oxandrolone, stimulates protein synthesis, increase cartilage and bone growth.

Study Links Increased BPA Levels To Canned Soup Consumption

Regular consumption of canned foods contribute to higher levels of bisphenol A (BPA)�in urine,�a chemical compound�that�is usually�associated with an increased risk of onset of hormone-dependent cancers,�that�include�breast cancer�and�prostate cancer, according to a�new study.

According to U.S. study – conducted by researchers at Harvard University and published in the Journal of the American Medical Association – people who�consumed for five consecutive days canned soup�had a urinaty�value of��bisphenol A,��1,200 times higher than�peers that�consumed�fresh soup.

Tin Soup Can

The study is presented as “one of the first to quantify the level of bisphenol A in humans after ingestion of food cans.”

It was already�known that bisphenol�A levels, increase�in the body�after drinking liquids which were long stored in certain plastic containers,�according to�Jenny Carwile coauthor of the study.

This particular study suggests that canned foods may be a�more important matter of concern, especially�in individuals that are�using canned�on a very�large-scale.

Bisphenol A is a chemical compound present in large quantity�in plastic products – its role is to�make the plastic��‘unbreakable’�– the plastic film lining the tins of canned drinks, and�some�dental amalgams, is associated with other substances�considered �“endocrine disrupters”,� increased�risk for developing�hormone-dependent cancers, especially breast and prostate.

The study involved 75 people who�ate for five consecutive days canned soup�and�fresh soup�without changing any other dietary habit. The�analysis of the�urine samples evidentiated after five days,�a raise of�the level of bisphenol A 1,200�above the normal�value in consumers of canned soup.

But the risk was considered a temporary one, after bisphenol�A was eliminated in urine. Researchers could not determine the amount of bisphenol A which still�remains in the body after consumption of canned food,�and�larger�regarding this matter would be necessary.

In France, the National Assembly adopted on 12 October, a measure prohibiting the use of bisphenol A in the manufacture of food containers�from 2014 (2013�for food containers used by children under the age of�three).